Randomized comparison of debulking followed by stenting versus stenting alone for ostial left anterior descending artery stenosis: Intravascular ultrasound guidance

Young Hak Kim, Myeong Ki Hong, Seung Whan Lee, Cheol Whan Lee, Ki Hoon Han, Jae Joong Kim, Seung Wook Park, Gary S. Mintz, Seung Jung Park

Research output: Contribution to journalArticle

12 Citations (Scopus)

Abstract

Background Although directional coronary atherectomy (DCA) before stenting has the advantage of combining substantial removal of atheromatous plaque and prevention of elastic recoil, there has been no randomized study to investigate its efficacy in ostial left anterior descending artery (LAD) lesions. This study was aimed to evaluate the effect of DCA followed by stenting on ostial LAD stenosis under the guidance of intravascular ultrasound (IVUS). Methods Eighty-six patients with ostial LAD stenoses were randomly assigned to DCA followed by stenting (group I) or stenting alone (group II). Aggressive DCA or optimal stenting was performed in both groups under the guidance of IVUS. The primary end point was angiographic restenosis at 6 months. Results Baseline clinical and angiographic characteristics were similar between the 2 groups. The postprocedural minimal lumen diameter was larger in group I than group II (4.0 ± 0.4 mm vs. 3.5 ± 0.5 mm, P < .001). However, the angiographic restenosis rates were not significantly different between the 2 groups (9/32 [28.1%] in group I vs. 11/30 [36.7%] in group II, P = .472). The postprocedural IVUS stent area was the only independent determinant of restenosis by multivariate analysis (odds ratio .61, 95% CI 0.41-0.92, P = .018). Conclusions DCA followed by stenting achieved greater lumen gain than stenting alone for ostial LAD stenosis. However, DCA did not improve angiographic restenosis.

Original languageEnglish
Pages (from-to)663-669
Number of pages7
JournalAmerican heart journal
Volume148
Issue number4
DOIs
Publication statusPublished - 2004 Oct 1

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Coronary Atherectomy
Pathologic Constriction
Arteries
Atherosclerotic Plaques
Stents
Multivariate Analysis
Odds Ratio

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine

Cite this

Kim, Young Hak ; Hong, Myeong Ki ; Lee, Seung Whan ; Lee, Cheol Whan ; Han, Ki Hoon ; Kim, Jae Joong ; Park, Seung Wook ; Mintz, Gary S. ; Park, Seung Jung. / Randomized comparison of debulking followed by stenting versus stenting alone for ostial left anterior descending artery stenosis : Intravascular ultrasound guidance. In: American heart journal. 2004 ; Vol. 148, No. 4. pp. 663-669.
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title = "Randomized comparison of debulking followed by stenting versus stenting alone for ostial left anterior descending artery stenosis: Intravascular ultrasound guidance",
abstract = "Background Although directional coronary atherectomy (DCA) before stenting has the advantage of combining substantial removal of atheromatous plaque and prevention of elastic recoil, there has been no randomized study to investigate its efficacy in ostial left anterior descending artery (LAD) lesions. This study was aimed to evaluate the effect of DCA followed by stenting on ostial LAD stenosis under the guidance of intravascular ultrasound (IVUS). Methods Eighty-six patients with ostial LAD stenoses were randomly assigned to DCA followed by stenting (group I) or stenting alone (group II). Aggressive DCA or optimal stenting was performed in both groups under the guidance of IVUS. The primary end point was angiographic restenosis at 6 months. Results Baseline clinical and angiographic characteristics were similar between the 2 groups. The postprocedural minimal lumen diameter was larger in group I than group II (4.0 ± 0.4 mm vs. 3.5 ± 0.5 mm, P < .001). However, the angiographic restenosis rates were not significantly different between the 2 groups (9/32 [28.1{\%}] in group I vs. 11/30 [36.7{\%}] in group II, P = .472). The postprocedural IVUS stent area was the only independent determinant of restenosis by multivariate analysis (odds ratio .61, 95{\%} CI 0.41-0.92, P = .018). Conclusions DCA followed by stenting achieved greater lumen gain than stenting alone for ostial LAD stenosis. However, DCA did not improve angiographic restenosis.",
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Randomized comparison of debulking followed by stenting versus stenting alone for ostial left anterior descending artery stenosis : Intravascular ultrasound guidance. / Kim, Young Hak; Hong, Myeong Ki; Lee, Seung Whan; Lee, Cheol Whan; Han, Ki Hoon; Kim, Jae Joong; Park, Seung Wook; Mintz, Gary S.; Park, Seung Jung.

In: American heart journal, Vol. 148, No. 4, 01.10.2004, p. 663-669.

Research output: Contribution to journalArticle

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T1 - Randomized comparison of debulking followed by stenting versus stenting alone for ostial left anterior descending artery stenosis

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AU - Kim, Young Hak

AU - Hong, Myeong Ki

AU - Lee, Seung Whan

AU - Lee, Cheol Whan

AU - Han, Ki Hoon

AU - Kim, Jae Joong

AU - Park, Seung Wook

AU - Mintz, Gary S.

AU - Park, Seung Jung

PY - 2004/10/1

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N2 - Background Although directional coronary atherectomy (DCA) before stenting has the advantage of combining substantial removal of atheromatous plaque and prevention of elastic recoil, there has been no randomized study to investigate its efficacy in ostial left anterior descending artery (LAD) lesions. This study was aimed to evaluate the effect of DCA followed by stenting on ostial LAD stenosis under the guidance of intravascular ultrasound (IVUS). Methods Eighty-six patients with ostial LAD stenoses were randomly assigned to DCA followed by stenting (group I) or stenting alone (group II). Aggressive DCA or optimal stenting was performed in both groups under the guidance of IVUS. The primary end point was angiographic restenosis at 6 months. Results Baseline clinical and angiographic characteristics were similar between the 2 groups. The postprocedural minimal lumen diameter was larger in group I than group II (4.0 ± 0.4 mm vs. 3.5 ± 0.5 mm, P < .001). However, the angiographic restenosis rates were not significantly different between the 2 groups (9/32 [28.1%] in group I vs. 11/30 [36.7%] in group II, P = .472). The postprocedural IVUS stent area was the only independent determinant of restenosis by multivariate analysis (odds ratio .61, 95% CI 0.41-0.92, P = .018). Conclusions DCA followed by stenting achieved greater lumen gain than stenting alone for ostial LAD stenosis. However, DCA did not improve angiographic restenosis.

AB - Background Although directional coronary atherectomy (DCA) before stenting has the advantage of combining substantial removal of atheromatous plaque and prevention of elastic recoil, there has been no randomized study to investigate its efficacy in ostial left anterior descending artery (LAD) lesions. This study was aimed to evaluate the effect of DCA followed by stenting on ostial LAD stenosis under the guidance of intravascular ultrasound (IVUS). Methods Eighty-six patients with ostial LAD stenoses were randomly assigned to DCA followed by stenting (group I) or stenting alone (group II). Aggressive DCA or optimal stenting was performed in both groups under the guidance of IVUS. The primary end point was angiographic restenosis at 6 months. Results Baseline clinical and angiographic characteristics were similar between the 2 groups. The postprocedural minimal lumen diameter was larger in group I than group II (4.0 ± 0.4 mm vs. 3.5 ± 0.5 mm, P < .001). However, the angiographic restenosis rates were not significantly different between the 2 groups (9/32 [28.1%] in group I vs. 11/30 [36.7%] in group II, P = .472). The postprocedural IVUS stent area was the only independent determinant of restenosis by multivariate analysis (odds ratio .61, 95% CI 0.41-0.92, P = .018). Conclusions DCA followed by stenting achieved greater lumen gain than stenting alone for ostial LAD stenosis. However, DCA did not improve angiographic restenosis.

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